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Tuesday, September 4, 2012

Code for the Day: Pillow Fights in the Dark Are a Bad Idea - Y93.83

I am that geek who asks for copies of my operative reports. My doctors usually look at me a little weird and tell me how boring they are, but nonetheless, I collect operative reports. I have certain friends, family, and coworkers who have joined the cause and will ask for copies of the report for whatever procedure they had done recently. In fact, I recently acquired a tonsillectomy.

While this may seem to be a rather strange collection, for me it's purely educational. I like to teach from real operative reports, so I collect them and use them in training materials. A couple of weeks ago, I dusted off one of my previous procedure reports in preparation for ICD-10-PCS training. It was for a septoplasty and turbinate reduction after what one of my doctor's not-so-lovingly referred to my as my "100-day cold." When I finally saw a specialist, she determined that I had trouble due to a deviated septum, which was caused by an old fracture - probably during childhood.

When I told my mother that I had a deviated septum, probably due to an old nasal fracture from childhood, she could see where I was going. We both knew how my nose got broken and who did it.

My brother and I were pretty close growing up. Only three years apart in age, we spent a lot of weekends and cold snowy days playing together. On the fateful night in question, I remember we were in his room having a pillow fight. Mom and Dad were watching TV in the living room. We had been smacking each other around with pillows for a bit when we decided to add a degree of difficulty. Let's turn out the lights! It's all fun and games until someone gets smashed in the nose with a fist. Unfortunately, it was my nose, which immediately began gushing blood.

I remember thinking one thing and one thing only: if I holler loud enough, my parents will come down the hall to see what's up and my brother will get in a lot of trouble for decking his little sister in the nose. It didn't work. I had a lot of nosebleeds as a child and my brother had watched my Mom stop the bleeding many times before. Within seconds, he had me lying on the bathroom floor with one of the nosebleed-approved washcloths and he was mopping up the blood, making sure I was pinching the bridge of my nose, and telling me shut up before Mom came down the hall. Duh. That was the point!

The bleeding stopped. Several minutes later, Mom came down the hall, asked what happened, saw that my brother had the situation under control, and returned to the living room. Well, that plan kind of backfired. It seems the fact it actually was an accident and his nurturing nature prevented him from getting in trouble.

At any rate, about 25 years later I found myself sitting in the office of an ENT who wanted to straighten out my septum. And then I realized that there's a code for this after-the-fact injury and I was very excited!

S02.2xxA, Fracture of nasal bones, initial encounter

Y93.83, Activity, rough housing and horseplay

Y92.013, Bedroom of single-family (private) house as the place of
occurrence of the external cause

The codes here refer to the initial injury, had I received medical treatment. I love that there is a specific code for horseplay as the activity. And check out that place of occurrence code - it's pretty darn specific, down to the bedroom of a single-family home.Of note, had my doctor documented in my record at the time of surgery that this was due to an old nasal fracture, I could have used this code:

S02.2xxS, Fracture of nasal bones, sequela

As for my brother, he loves this story. I remember relaying the saga to him one evening when we both happened to be in the same state during a business trip. When his wife phoned soon after that, he proudly declared to her that he had broken his sister's nose. "Just now?!," she exclaimed and then he had to tell her the story. It's funny now - especially years after the surgery. But if you have kids, just warn them. Pillow fights in the dark are a bad, bad idea.